A Year Into the Pandemic, Science Carries on at ACC

Fourteen months ago, the American College of Cardiology (ACC) was the first large scientific organization to call the audible: its annual meeting, normally a gathering of around 17,000, would be canceled as COVID-19 swept the globe. Unlike meetings that were canceled outright, ACC was held virtually, on just 15 days’ notice.

In doing so, ACC set the standard others would follow: organizers showed that scientists could collaborate from their offices, share slides, answer questions, and even present late-breaking trials. And they did so as many cardiologists were on the front lines in those first scary months, as COVID-19 swept through China, Italy, and New York City. Cardiologists gained knowledge day by day of how the virus hit their patients with particular brutality, limiting the blood’s ability to carry oxygen to organs, causing blood clots, and attacking the kidneys. Even some previously healthy survivors had lingering cardiovascular effects.

In September 2020, ACC moved this year’s event to May 15-17, from its customary mid-March calendar slot, with hope that the arrival of vaccines would allow everyone to gather in Atlanta. But for the second year, the meeting is virtual only. And while event organizers acknowledge that COVID-19 has made conducting science more challenging, they feel they’ve ended up with a full plate of findings to present: ACC accepted more than 3400 abstracts from 5258 submissions and 25 late-breaking clinical trials from 116 submissions.

“Much like patient visits and telehealth, there really was a learning curve in terms of how we could continue to conduct trials in a socially distant environment,” said Pamela Bowe Morris, MD, the scientific chair of ACC.21, who is a preventive cardiologist at the Medical University of South Carolina, in Charleston. “I don't think there's any question that has slowed, somewhat, some of the progress that we've made. But there’s no question that we've also surmounted many of those obstacles.”

The meeting’s scientific vice chair, Douglas Drachman, MD, an interventional cardiologist from Massachusetts General Hospital, agreed. He added that during stretches when clinical care was limited, “many people had a lot more time to be writing and submitting their research.”

Heart failure is a major focus of this year’s meeting, both in clinical trials and in sessions, including an on-demand symposium led by Valetin Fuster, MD, chief of cardiology at Icahn School of Medicine at Mount Sinai. Participant Clyde W. Yancy, MD, of Northwestern University, told The American Journal of Managed Care^® that he will endorse distinguishing a third phenotype of heart failure, between preserved and reduced ejection fraction, a topic that came up during an FDA advisory panel discussion late last year. The symposium will be available to participants starting Saturday morning.

Clinical trials and other results of note include:

• ADAPTABLE (Aspirin Dosing: A patient-centric Trial Assessing the Benefits and Long-term Effectiveness), being presented Saturday at 9 am ET, will provide data on the optimal dosage of aspirin in secondary prevention of cardiovascular disease.
• EXPLORER HCM: This late-breaking oral presentation, taking place Saturday at 12:15 pm, will report results from a new analysis of the phase 3 trial of mavacamten, which is under review at FDA to treat patients with obstructive hypertrophic cardiomyopathy (HCM).
• DARE-19: Although AstraZeneca has announced that results for this trial did not achieve statistical significance, there is still great interest in the details of this study. Investigators studied the use of the SGLT2 inhibitor dapagliflozin in patients diagnosed with COVID-19. This is being presented Sunday at 8:15 am.
• STRENGTH: This presentation by Cleveland Clinic’s Steven Nissen, MD, titled, “Relationship Between Omega-3 Fatty Acid Levels And Major Adverse Cardiovascular Outcomes In Patients With High Cardiovascular Risk,” follows the presentation of results of the STRENGTH trial last November. Then, a different Cleveland Clinic investigator, A. Michael Lincoff, MD, tried to explain a negative result by questioning the placebo used in the REDUCE-IT trial, involving a rival omega-3 fatty acid. A commentator on the Sunday morning panel is Harvard Medical School’s Deepak L. Bhatt, MD, MPH, who has produced a string of impressive results from REDUCE-IT and noted that the 2 omega 3 fatty acid formulations are not the same.

Follow-up results from earlier trials abound. Bhatt will present results on involving sotagliflozin, an SGLT1/2 inhibitor. In November, he showed this drug had a signal in heart failure with preserved ejection fraction (HFpEF), which had eluded treatment prior to the recent approval for sacubitril / valsartan (Entresto). Bhatt’s presentation will involve benefits of sotagliflozin “across the full spectrum of ejection fraction,” including HFpEF.

New results involving last year’s ACC showstopper, vericiguat, now approved as Verquvo, will be offered Sunday at 1:30 p.m. The presentation, “Baseline Cardiac Troponin T, Clinical Outcomes and Vericiguat Treatment Effect in Heart Failure With Reduced Ejection Fraction: Insights From the VICTORIA Trial,” will discuss how higher baseline levels of cardiac Troponin T can be a way to indicate higher-risk patients—and a way to identify those who are candidates for treatment with vericiguat.

And Monday will bring a secondary analysis for GALACTIC-HF, during a late-breaking session that will look at “the impact of ejection fraction on the therapeutic effect of omecamtiv mecarbil in patients with heart failure and reduced ejection fraction.”